Nationwide survey of Indian cardiac surgeons on the management of acute type A aortic dissection.

Objective: Acute Type A aortic dissection (ATAAD) is associated with high morbidity and mortality, and management strategies vary widely among surgeons. This study aimes to evaluate practice patterns and decision-making among Indian cardiac surgeons regarding ATAAD, with focus on differences related to surgical experience and institutional case volume. Methods: A 23-item electronic questionnaire covering preoperative, intraoperative and postoperative management of ATAAD was distributed to all members of the Indian Association of Cardiovascular-Thoracic Surgeons. Ninety-three responses were analyzed and compared according to surgeon experience (<10, 10-20, >20 years) and institutional aortic surgery volume (high vs low). Results: Over one-quarter of surgeons (26.9 %) declined to operate on patients >70 years old, a practice more frequent among surgeons with <20 years of experience (32% vs 5.56 % p=0.011). Active cardiopulmonary resuscitation (56 %), and preoperative stroke (52.7%) were the most common reasons to withhold surgery, whereas senior surgeons (>20 years) were more likely to operate despite malperfusion or CPR (38.8 % vs 13.3 %, p=0.005).Dual arterial cannulation was preferred by 62.4% of surgeons, with a shift toward single site cannulation with increasing experience (p=0.008). The distal anastomosis was performed using on-clamp technique by 26.8 % of respondents, more frequently among low-volume aortic surgeons (35.1 % vs 13.8%, p=0.012). Conclusion: Management of ATAAD in India shows substantial variation, strongly influenced by surgeon experience and aortic surgery volume. Differences are particularly evident in patients selection, cannulation strategy and distal repair techniques. These findings highlight the need for structured referral systems and the potential benefit of developing high-volume 'aortic centres' in India.